With foundation-model features, aggregator complexity does not improve cross-hospital discrimination in gastric whole-slide image classification
Read the original on arXiv Computer Vision →The study evaluated whole‑slide image classifiers for gastric cancer across five Korean hospitals, using foundation‑model features and leave‑one‑hospital‑out validation. A hierarchical patch‑region‑slide graph aggregator (CHIME‑MIL) with site alignment and two‑scale fusion achieved a mean AUC of 0.837, outperforming six conventional attention and transformer aggregators that lacked these steps. However, when matched with the same alignment and fusion, CHIME‑MIL did not surpass simple attention‑based pooling, and global max pooling performed best (AUC 0.855). The alignment step, which subtracts each hospital’s mean feature vector without labels, enabled onboarding of a new hospital from only ten unlabeled slides but yielded only a modest 0.002 AUC improvement, and the model’s accuracy gains were inconsistent. "whyItMatters":"The findings show that adding complex aggregation methods does not necessarily improve cross‑hospital discrimination, highlighting the importance of simpler, label‑free onboarding and calibration checks for deployable pathology systems."
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